The Plank

The Dirty (and Unhealthy) South


Forbes is out with a ranking of the healthiest
and least healthy states
. Not surprisingly, eight of the ten least healthy
are in the South (nine if you count Oklahoma).
My own home state, Tennessee,
comes in at 47th. Only 22 percent of children between 19 to 35 months in the
state get immunized, there are only 17 doctors per 100,000 people, and 47
percent of the population is obese.

On one level, these numbers appear to be a ringing indictment
of the state’s two-term Democratic governor, Phil Bredesen, a former
health-care executive who promised to fix the state’s ailing health care
system. But it’s not quite so easy. As Jason Zengerle documented in these pages
back in the early 2000s (sorry, the archive isn’t available), Tennessee is a
rabidly anti-tax state, where even the mention of a state income tax brought
out massive protests in front of the state capitol and destroyed the second-term
hopes of Bredesen’s predecessor, Republican Don Sundquist. Instead of income or
property taxes, the state relies almost entirely on a punishingly high sales tax—7
percent on general goods, and 5.5 percent on food. Most states don’t even tax
food, and only Mississippi
has a higher levy. Predictably, this means lots of people buying high-calorie,
low-nutrition junk food, with all its attendant health and social problems.


But even this isn’t enough revenue; Bredesen has had to make
dramatic cuts in the state’s Medicaid supplement program, TennCare, and liberal
critics say he cut too far. (Of course, they’re outnumbered by conservative
critics, who think he didn’t cut far enough.) It was painful enough to watch
him to have gut TennCare, but it was even more painful to watch most of the
state cheer him on.


The irony is that Tennessee,
and in particular Nashville,
is home to a robust health-care industry, most notably the Frist family’s
Columbia/HCA and Vanderbilt’s enormous health care center. The result is a Dickensian
health care sector, driven entirely by profit. As my brother, a high school
counselor, puts it, Tennessee
is a great place to live if you can afford health care, and an absolutely
horrible place to live if you can’t.


--Clay Risen

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